AB1372 PREDICTING ACUPUNCTURE EFFICACY IN FIBROMYALGIA: RESULTS OF A PRAGMATIC OPEN-LABEL STUDY
Authors: M. Di Carlo, G. Beci, E. Cipolletta, F. Salaffi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Fibromyalgia (FM) is a condition mainly characterized by the presence of chronic widespread musculoskeletal pain that affects a large proportion of the general population. Acupuncture, like other complementary and alternative medicines, is a patient-centered treatment and is generally well tolerated and appreciated by patients and the latest EUropean League Against Rheumatism (EULAR) recommendations on the management of FM made a weak recommendation for acupuncture in FM. To date, there is no study that indicates which variables predict response to acupuncture treatment in FM, either in terms of immediate response or persistence of response, and thus can enable the implementation of personalized treatment a prevention of therapeutic failure. <h3>Objectives</h3> The aim of this study is to identify the predictive factors of failure to acupuncture in patients with FM. <h3>Methods</h3> FM patients refractory to standard drug therapy (defining as standard drug theraphy the association of duloxetine and pregabalin) underwent eight weekly acupuncture sessions. Significant improvement, defined as a reduction of at least 30% of the FIQR, was assessed at the end of the eight weeks (T1) of treatment and three months after the end of treatment (T2). Univariate analysis was conducted to identify predictors of significant improvement at T1 and T2. Variables, which resulted significantly associated with clinical improvement at univariate analysis, were included in multivariate models. <h3>Results</h3> Analyses were conducted on 77 patients (9 males, 11.7%). At T1, significant improvement in FIQR was recorded in 44.2% of patients. At T2, significant improvement in FIQR persisted in 20.8% of patients. In multivariate analysis, predictive variables of treatment failure were tender point count (TPC) (odds ratio [OR] = 0.49, 95% confidence interval [95% CI]: 0.28 – 0.86, p = 0.01) and pain magnification (OR = 0.68, 95% CI: 0.47 – 0.99, p = 0.04) assessed with Pain Catastrophizing Scale, at T1. At T2, the only predictive variable of treatment failure was concomitant duloxetine use (OR = 0.21, 95% CI: 0.05 – 0.95, p = 0.04) (Table 1). <h3>Conclusion</h3> High TPC and a tendency for pain magnification predict immediate treatment failure, while duloxetine therapy predicts it three months after completion of the acupuncture course. The identification of clinical characteristics of unfavorable response to acupuncture could help to implement a cost-effective prevention of treatment failure in FM. The results of this study can provide a reference for the integration of a non-drug treatment such as acupuncture into the complex FM scenario. <h3>References</h3> [1]Sarzi-Puttini P et al.: Fibromyalgia position paper. Clin Exp Rheumatol 2021; 39 Suppl 130: 186-93. https://doi.org/10.55563/clinexprheumatol/i19pig. [2]Di Carlo M et al. Acupuncture for Fibromyalgia: An Open-Label Pragmatic Study on Effects on Disease Severity, Neuropathic Pain Features, and Pain Catastrophizing. Evid Based Complement Alternat Med 2020; 2020: 9869250. https://doi.org/10.1155/2020/9869250. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.